BUNIONS – PATIENT INFORMATION LEAFLET

WHAT ARE BUNIONS?

A bunion is a common deformity affecting the big toe joint. Medically it is known as ‘Hallux Valgus’. It is effectively osteoarthritis of the joint.

The main symptom is a change in the shape of the big toe joint. Not everyone will get pain, but the bunion may cause problems with footwear which in turn causes rubbing on the skin.

Visually, bunions can be classified into four types: normal, mild, moderate and severe:

Normal Mild Moderate Severe

However, the more severe it looks does not mean that it will be more painful or limiting. For patients and clinicians alike, it is not that straightforward and each bunion has to be considered on an individual basis.

Practically, bunions can be divided into two types:

Type one: Footwear related bunions - usually there is a bony prominence which rubs on the shoe, causing it to become red (cherry tomato on the side of the foot) and painful.

Type two: May have the same feature as type one, but a deep joint pain will also be experienced.

QUESTIONS TO ASK YOURSELF

In order to help measure how problematic your bunion is, ask yourself the following questions:

 Is it painful every day?  Does it restrict any of your activities e.g. work, getting to the shops, doing the housework, hobbies etc?  Is it a deep and/or on the surface pain?  Does footwear make it worse?  Is it painful even without shoes on?  Would you consider surgery?

WHAT ARE THE SYMPTOMS?

 A change in the shape of the big toe joint. Does yours look like one on the visual scale above?  Not everyone will get pain. Those that do may describe anything from a toothache-like pain, to a sharp, searing pain. It maybe constant or periodic in occurrence  Problems with footwear causing rubbing on the skin which may become painful and sore  As the deformity progresses, a reduction in the movement of the joint may be experienced. It is not uncommon to experience clicking of the joint, which may or may not be painful

WHY DID I GET IT?

There are multiple cause of bunions. Bunions tend to run in families and the most likely cause is the shape of the bones in your foot. For example, if your metatarsal head (the bone just behind the base of your big toe) is very rounded, it will make it easier for the joint to turn to the side when sideways pressure is applied.

That sideways pressure usually comes from footwear. Though it is not a cause in itself, footwear will apply the force to make the bunion develop.

You can find more information on footwear advice on the Sheffield Foot and Ankle Pain website (www.sheffieldfootandanklepain.com)

WHAT CAN I DO TO MAKE IT BETTER?

Firstly, just because you have a bunion does not mean you have to do anything. If it’s not bothering you, leave it alone.

However, bunions can be painful and can have a big impact on your mobility. They can also cause people to become self-conscious of their feet.

Unfortunately there is no way of knowing if your bunion will progress and if it does how quickly this will happen. The best thing to do is to ask an older family member who also has bunions what theirs did.

There are only a few treatments and a number of these can be self administered, so your symptoms may be resolved without even seeing a health professional.

 Adapt your footwear: As mentioned above, footwear can be a key factor in the development of bunions.

On a foot without a bunion, the distance from the heel to the big toe joint is approximately two thirds of the total length of the foot. Shoe manufacturers make their shoes to these ratios.

However, on a foot with a bunion, this length ratio changes to approximately three quarters. This explains why it can be difficult to get shoes to fit.

An initial response is to buy a bigger shoe, but this means that the new shoe does not fit any other part of your foot and it can feel as though it will come off.

Shoe stretchers and shoe modifications can help loosen the pressure areas and make your shoes more comfortable to wear.

You can find more information about wearing the right footwear and how to assess your current footwear at www.sheffieldfootandanklepain.com

 Glucosamine with Chodrotin Sulphate: This is a supplement that can be helpful with joint pain. You can buy it from chemists, supermarkets and health food shops. The daily dosage is 1.5g per day.

If, after one month, the supplement is not working, then stop. People taking Warfarin should not take this supplement. Check the label for advice on taking it and the possible side-effects

If you are still having problems after trying the above treatments, then the next step would be to see your GP for a referral into The PhysioWorks (Foot & Ankle) Service.

Initially, they will assess your problem and further investigate as necessary. Once they have a diagnosis then further management will be undertaken.